Up from the grave he arose

Wow! What an experience I’ve just had. Thing only thing I barely remember last Sunday was that the Steelers won the Super Bowl. The last couple of days had me wondering. I do think it’s the worst I have ever been with the LBD.

I’ve underlined the worst symptoms I had in the following review of LBD which I posted last week.


Lewy Body Dementia Symptoms as explained by the Lewy Body Dementia Association

Dementia is a process whereby the person becomes progressively confused. The earliest signs are usually memory problems, changes in their way of speaking, such as forgetting words, and personality problems. Cognitive symptoms of dementia include poor problem solving, difficulty with learning new skills and impaired decision making.

Other causes of dementia should be ruled out first, such as alcoholism, overuse of medication, thyroid or metabolic problems. Strokes can also cause dementia. If these reasons are ruled out then the person is said to have a degenerative dementia. Lewy Body Dementia is second only to Alzheimer’s disease as the most common form of dementia.

Fluctuations in cognition will be noticeable to those who are close to the person with LBD, such as their partner. At times the person will be alert and then suddenly have acute episodes of confusion. These may last hours or days. Because of these fluctuations, it is not uncommon for it to be thought that the person is “faking”. This fluctuation is not related to the well-known “sundowning” of Alzheimer’s. In other words, there is no specific time of day when confusion can be seen to occur.

Hallucinations are usually, but not always, visual and often are more pronounced when the person is most confused. They are not necessarily frightening to the person. Other modalities of hallucinations include sound, taste, smell, and touch.

Parkinsonism or Parkinson’s Disease symptoms, take the form of changes in gait; the person may shuffle or walk stiffly. There may also be frequent falls. Body stiffness in the arms or legs, or tremors may also occur. Parkinson’s mask (blank stare, emotionless look on face), stooped posture, drooling and runny nose may be present.

REM Sleep Behavior Disorder (RBD) is often noted in persons with Lewy Body Dementia. During periods of REM sleep, the person will move, gesture and/or speak. There may be more pronounced confusion between the dream and waking reality when the person awakens. RBD may actually be the earliest symptom of LBD in some patients, and is now considered a significant risk factor for developing LBD. (One recent study found that nearly two-thirds of patients diagnosed with RBD developed degenerative brain diseases, including Lewy body dementia, Parkinson’s disease, and multiple system atrophy, after an average of 11 years of receiving an RBD diagnosis. All three diseases are called synucleinopathies, due to the presence of a mis-folded protein in the brain called alpha-synuclein.)

Sensitivity to neuroleptic (anti-psychotic) drugs is another significant symptom that may occur. These medications can worsen the Parkinsonism and/or decrease the cognition and/or increase the hallucinations. Neuroleptic Malignancy Syndrome, a life-threatening illness, has been reported in persons with Lewy Body Dementia. For this reason, it is very important that the proper diagnosis is made and that healthcare providers are educated about the disease.

Other Symptoms

Visuospatial difficulties, including depth perception, object orientation, directional sense and illusions may occur.

Autonomic dysfunction, including blood pressure fluctuations (e.g. postural/orthostatic hypotension) heart rate variability (HRV), sexual disturbances/impotence, constipation, urinary problems, hyperhidrosis (excessive sweating), decreased sweating/heat intolerance, syncope (fainting), dry eyes/mouth, and difficulty swallowing which may lead to aspiration pneumonia.

Other psychiatric disturbances may include systematized delusions, aggression and depression. The onset of aggression in LBD may have a variety of causes, including infections (e.g., UTI), medications, misinterpretation of the environment or personal interactions, and the natural progression of the disease.

I’m coming back to myself once again–

Now to start catching up with 1009 emails. I’ll just do it little by little.

Warmly………David

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Boys and Sports

First of all, I’d like to thank those of you who’ve already voted for the blog, for all those who’ve made comments and to those of you who like the new blog look. I keep experimenting with different themes………I think I’ll stick with this one. It gives me a few more options which I can use over time. Plus it just seems easier to read.

I thought I’d post a little review on the symptoms of Lewy Body Dementia.

Lewy Body Dementia Symptoms as explained by the Lewy Body Dementia Association

In this section we’ll discuss each of the symptoms, starting with the key word: dementia. Dementia is a process whereby the person becomes progressively confused. The earliest signs are usually memory problems, changes in their way of speaking, such as forgetting words, and personality problems. Cognitive symptoms of dementia include poor problem solving, difficulty with learning new skills and impaired decision making.

Other causes of dementia should be ruled out first, such as alcoholism, overuse of medication, thyroid or metabolic problems. Strokes can also cause dementia. If these reasons are ruled out then the person is said to have a degenerative dementia. Lewy Body Dementia is second only to Alzheimer’s disease as the most common form of dementia.

Fluctuations in cognition will be noticeable to those who are close to the person with LBD, such as their partner. At times the person will be alert and then suddenly have acute episodes of confusion. These may last hours or days. Because of these fluctuations, it is not uncommon for it to be thought that the person is “faking”. This fluctuation is not related to the well-known “sundowning” of Alzheimer’s. In other words, there is no specific time of day when confusion can be seen to occur.

Hallucinations are usually, but not always, visual and often are more pronounced when the person is most confused. They are not necessarily frightening to the person. Other modalities of hallucinations include sound, taste, smell, and touch.

Parkinsonism or Parkinson’s Disease symptoms, take the form of changes in gait; the person may shuffle or walk stiffly. There may also be frequent falls. Body stiffness in the arms or legs, or tremors may also occur. Parkinson’s mask (blank stare, emotionless look on face), stooped posture, drooling and runny nose may be present.

REM Sleep Behavior Disorder (RBD) is often noted in persons with Lewy Body Dementia. During periods of REM sleep, the person will move, gesture and/or speak. There may be more pronounced confusion between the dream and waking reality when the person awakens. RBD may actually be the earliest symptom of LBD in some patients, and is now considered a significant risk factor for developing LBD. (One recent study found that nearly two-thirds of patients diagnosed with RBD developed degenerative brain diseases, including Lewy body dementia, Parkinson’s disease, and multiple system atrophy, after an average of 11 years of receiving an RBD diagnosis. All three diseases are called synucleinopathies, due to the presence of a mis-folded protein in the brain called alpha-synuclein.)

Sensitivity to neuroleptic (anti-psychotic) drugs is another significant symptom that may occur. These medications can worsen the Parkinsonism and/or decrease the cognition and/or increase the hallucinations. Neuroleptic Malignancy Syndrome, a life-threatening illness, has been reported in persons with Lewy Body Dementia. For this reason, it is very important that the proper diagnosis is made and that healthcare providers are educated about the disease.

Other Symptoms

Visuospatial difficulties, including depth perception, object orientation, directional sense and illusions may occur.

Autonomic dysfunction, including blood pressure fluctuations (e.g. postural/orthostatic hypotension) heart rate variability (HRV), sexual disturbances/impotence, constipation, urinary problems, hyperhidrosis (excessive sweating), decreased sweating/heat intolerance, syncope (fainting), dry eyes/mouth, and difficulty swallowing which may lead to aspiration pneumonia.

Other psychiatric disturbances may include systematized delusions, aggression and depression. The onset of aggression in LBD may have a variety of causes, including infections (e.g., UTI), medications, misinterpretation of the environment or personal interactions, and the natural progression of the disease.

All right now. Enough of some serious material. Now it’s time to play. These are the kind of puzzles which make me feel really smart. The more I do, the smarter I feel. I hope they help you just as much.

Boys and Sports
by Shelly Hazard

Wilma and three other women were comparing notes about the achievements of their sons. Each son had a favorite sport and each was a star player. The boys ranged in age from 10 years old to 13 years old. Determine the full name of each mother, the name of her son, the sport each son played, and how old each son was.

1. Sara Copper’s son, who wasn’t Brian, didn’t play soccer.

2. The boy who played basketball was the youngest. Mrs. Green’s son was a year younger than the boy who played baseball but a year older than Sara’s son.

3. The oldest boy, who wasn’t Mark, was Sharon’s son but he didn’t play hockey.

4. The boy who played baseball was a year older than the boy who played hockey.

5. From youngest to oldest, the boys were Mark, Teresa’s son, Mrs. Silver’s son, and Eric.

6. Mrs. Wild’s son was two years older than Chris.

boyandsports1

boysandsports2

Click here for the Solution

Warmly………David

Thursday October 9, 2008

My hand, neck and head tremors are pronounced today so I have to type slowly. Thanks for spell checkers.

 

Anger, rage, resentment, a temper, hot under the collar, fly off the handle, livid, mad?????? ;

 

 

Bad, right? It scares you, right? Try to avoid it, right?  You’re not alone!

 

Some how we grew up thinking that anger is a bad thing and that we should never get angry or not allow ourselves to feel it. But it is a very normal and healthy emotion. We never question when we’re happy and joyful.

 

So why does anger exist and what do we do with it? You probably never thought about it but it’s simple. The purpose of anger is to bring about a positive and healthy change.

 

One key to controlling our temper is to have realistic expectations of others. No one is ever wrong or right all the time. It is wrong to expect others to always be happy and helpful. None of us are “up” all the time. We all have times that we are sick, stressed or just plain tired. And, right or wrong, these things do affect our moods.

 

We need to remember that other people are affected by these same things. They may have reasons for their seemingly rude behavior and are not just being selfish or thoughtless. We need to avoid getting offended every time people don’t respond or act the way we think they should. They might just be having a bad day.

 

We also need to remember that everyone and everything do not exist for our convenience or purpose. We will control anger better if we do not say things like “I can’t stand this …” or “They better never …” These statements lock us into emotionalizing rather than thinking.

 

Consider this…Learn to align yourself with reality. Don’t let everything bother you to the point that you always “lose it” over other people’s failures. Show them the same kind of understanding you would like to have on your challenging days.


Say a prayer — “Help me not to expect others to be perfect or to always do things my way. Make me willing to overlook offenses, to see people’s hearts and be sensitive to their needs.”

 

 

 

What is Lewy Body Dementia (LBD)?

 

v LBD is a progressive degenerative (deterioration) dementia.

 

v The following clinical features help distinguish LBD from Alzheimer’s  Disease (AD):

 

Ø Fluctuations (changes) in cognitive function (mental processes of perception, memory, judgment, and reasoning) with varying levels of alertness and attention: Clues to the presence of fluctuations include excessive daytime drowsiness (if nighttime sleep is adequate) or daytime sleep longer than 2 hours, staring into space for long periods, and episodes of disorganized speech.

 

Ø Visual hallucinations (sensory experiences of something that does not exist outside the mind)

 

Ø Parkinsonian motor features (resembling a group of nervous disorders similar to Parkinson’s disease, marked by muscular rigidity, tremor, and impaired motor control)

 

v Although extrapyramidal (involuntary movements) features may occur late in the course of AD, they appear relatively early in LBD.

 

Ø  Patients with AD virtually always have anterograde memory loss (affecting time immediately following trauma) as a prominent symptom and sign early in the course of the illness, anterograde memory loss may be less prominent in LBD. Experts have suggested that (one way of testing one’s word finding ability) patients with LBD do relatively better on tests of confrontation naming,  short and medium recall, and recognition than AD patients, whereas AD patients do better on tests of verbal fluency, visual perception, and performance tasks.

 

v     Executive function deficits (a term used to describe a set of mental processes that helps us connect past experience with present action. We use executive function when we perform such activities as planning, organizing, strategizing and paying attention to and remembering details) and visuospatial impairment (This is one component of cognitive functioning and it refers to our ability to process and interpret visual information about where objects are in space. This is an important aspect of cognitive functioning because it is responsible for a wide range of activities of daily living. For instance, it underlies our ability to move around in an environment and orient ourselves appropriately. Visuospatial perception is also involved in our ability to accurately reach for objects in our visual field and our ability to shift our gaze to different points in space) may be more prominent in persons with LBD than in those with AD.

 

v   Other symptoms that may alert clinicians to the diagnosis of LBD (versus AD)  include the following:

 

Ø  Nonvisual hallucinations

 

Ø  Delusions

 

Ø  Unexplained syncope (fainting)

 

Ø  Rapid eye movement sleep disorder (In a person with REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to “act out” his or her dreams. RBD is characterized by the acting out of dreams that are vivid, intense, and violent. Dream-enacting behaviors are usually nondirected include talking, yelling, punching, kicking, leaping, sitting, jumping from bed, arm flailing, and grabbing while still asleep. These behaviors are sometimes violent causing self-injury or injury to the bed partner. RBD is usually seen in middle-aged to elderly people (more often in men). The person may be awakened or may wake spontaneously during the attack and vividly recall the dream that corresponds to the physical activity).

 

Ø  Neuroleptic sensitivity (typical antipsychotic agents such as Haldol, Navane, Thorazine, Stelazine, Trilafon, Mellaril)

 

 

Enough already. My concentration and attention span are waning quickly. It has taken me over 3 hours just to prepare this small blog today.

 

Dr. David

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